SOFT TISSUE BIOMECHANICAL BEHAVIOR DURING ACUPUNTURE IN LOW BACK PAIN

针灸治疗腰痛时软组织的生物力学行为

• 批准号: 8166971
• 负责人: HELENE M LANGEVIN
• 金额: $ 5.22万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-03-01 至 2011-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8166971
• 关键词: Acupuncture Points; Acupuncture Therapy; Acupuncture procedure; Alternative Medicine; Architecture; Area; Articular Range of Motion; Back; Behavior; Biological; Biomechanics; Biopsy; Bladder; Chronic low back pain; Clinical; Clinical Trials; Clinical assessments; Collagen; Computer Retrieval of Information on Scientific Projects Database; Connective Tissue; Coupling; Data; Deposition; Disease; Engineering; Functional disorder; Funding; Future; Gallbladder; Grant; Human; Imagery; Individual; Institution; Intramuscular; Lead; Leg; Length; Location; Low Back Pain; Manuals; Measurement; Measures; Meridians; Modeling; Motion; Muscle; Nature; Needles; Orthopedics; Outcome Measure; Pain; Palpation; Patients; Pattern; Performance; Physical therapy; Physics; Play; Process; Property; Rehabilitation therapy; Research; Research Personnel; Resources; Role; Rotation; Series; Source; Techniques; Testing; Therapeutic; Thick; Time; Tissues; Torque; Ultrasonography; United States National Institutes of Health; Water; base; human subject; in vivo; insight; kinematics; multidisciplinary; primary outcome; response; soft tissue; subcutaneous; theories; trial comparing

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The principal aim of this proposal is to test the hypothesis that individuals with chronic low back pain (LBP) have altered soft tissue biomechanical behavior during acupuncture needling in the lower back and legs compared with individuals without LBP (No-LBP). We will also test whether or not altered tissue behavior in LBP is generalized, or localized to specific locations as predicted by traditional acupuncture theory. This proposal constitutes the first step to testing the mechanistic model that 1) altered soft tissue biomechanical behavior during needling in LBP is due to abnormalities of connective tissue (subcutaneous, perimuscular and/or intramuscular), 2) connective tissue plays an important role in both the therapeutic mechanism of acupuncture and the pathophysiological mechanism of LBP, and 3) these two mechanisms are related. Acupuncturists describe qualitatively different needling responses at locations believed to be "involved" in the patient's disease process. Although assessing abnormalities in the needling response is a fundamental aspect of acupuncture therapy, what constitutes a normal vs. abnormal needling response has never been studied quantitatively. Thus the nature of tissue changes underlying these phenomena remains unknown. We have recently developed a new in vivo technique based on ultrasound elastography in humans that allows visualization and quantification of tissue displacement and strain patterns developed in tissues during needle manipulation (65). In this proposal, we will use ultrasound elastography to perform measurement and detailed analysis of tissue biomechanical behavior during needling in human subjects with and without LBP. AIM 1: Examine tissue biomechanical behavior during acupuncture in LBP vs. No-LBP: 80 subjects with LBP and 80 control subjects without LBP will be tested. We will test acupuncture points (APs) and non-acupuncture points (Non-APs) on the Bladder (BL) and Gall Bladder (GB) meridians as well as Non-Meridian Non-APs in the back and leg. Primary outcome measures will be: 1) peak torque during needle rotation (Torque); 2) needle force decay rate during needle oscillation (Force decay); 3) tissue displacement (Displacement) in Subcutaneous, Perimuscular and Muscle zones during needle oscillation; 4) Perimuscular zone thickness (Thickness). Our preliminary data suggest that tissue behavior during needling in the lower back is abnormal in LBP. We hypothesize that Torque and Displacement are smaller and that Force decay and Thickness are greater 1) in LBP than in No-LBP, 2) at Meridians than at Non-Meridians, 3) at APs than at Non-APs, 4) in the back than in the leg. In LBP subjects, we will also examine the relationship between these outcome measures and 1) subjective pain pattern, 2) tenderness to palpation. AIM 2: Quantify tissue material properties responsible for biomechanical behavior observed in Aim 1: Data from Aim 1 will be used to develop, evaluate and implement a biomechanical model to quantify parameters including stiffness, damping and needle/tissue coupling time constant associated with each of three tissue zones (Subcutaneous, Perimuscular and Muscle). We hypothesize that stiffness is greater and that damping and needle/tissue coupling constant are smaller in LBP compared with No-LBP. These parameters also will be used to generate further hypotheses regarding connective tissue pathophysiological mechanisms potentially responsible for abnormal soft tissue behavior in LBP (e.g. increased or decreased tissue water content, abnormal connective tissue matrix architecture, increased or decreased collagen deposition). These hypotheses will be tested in future studies that will combine ultrasound elastography and tissue biopsies in LBP and No-LBP. AIM 3: Examine the relationship between tissue behavior during acupuncture and clinical assessment prior to needling: In all subjects tested in Aim 1, we will perform clinical measures of muscle length in areas that will be needled as well as range of motion (ROM) and functional assessments. These measurements will be compared with parameters calculated in Aim 2. We hypothesize that stiffness will be negatively correlated, and that damping and tissue coupling constants will be positively correlated with muscle length and ROM in corresponding muscle groups as well as physical performance measures. These data will pave the way for a future clinical trial comparing the effects of acupuncture and physical therapy using both subjective (pain reduction, functional assessment) and objective outcome measures (ultrasound elastography, bulk passive tissue stiffness, kinematic motion analysis and muscle activity) both before and after a series of treatments. This multidisciplinary study bridging the fields of alternative medicine, physical therapy, engineering, physics and orthopaedics will provide objective biomechanical measurements of phenomena fundamental to acupuncture. This study also may 1) lead to important new insights on the pathophysiology of LBP and 2) provide objective biological outcome measures for future clinical trials of acupuncture and other "alternative" manual therapies as well as physical and rehabilitation therapy.

这个子项目是许多利用 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 这项建议的主要目的是检验这一假设，即与没有LBP（无LBP）的个人相比，慢性腰痛（LBP）的个人在下背部和腿部针灸过程中改变了软组织生物力学行为。 我们还将测试是否改变组织行为在腰痛是普遍的，或本地化到特定位置的预测传统针灸理论。 该建议构成了测试以下机制模型的第一步：1）在针刺LBP期间改变的软组织生物力学行为是由于结缔组织（皮下、肌周和/或肌内）的异常，2）结缔组织在针刺的治疗机制和LBP的病理生理机制中起着重要作用，以及3）这两种机制是相关的。 针灸师描述定性不同的针刺反应的位置被认为是“参与”在病人的疾病过程。 虽然评估针刺反应的异常是针灸治疗的一个基本方面，但什么是正常与异常针刺反应从未被定量研究过。 因此，这些现象背后的组织变化的性质仍然未知。我们最近开发了一种新的基于人体超声弹性成像的体内技术，该技术允许在针操作期间可视化和量化组织中产生的组织位移和应变模式（65）。 在这个建议中，我们将使用超声弹性成像进行测量和详细分析的组织生物力学行为在针刺过程中，在人类受试者与LBP。 目标1：检查LBP与无LBP针灸期间的组织生物力学行为：将测试80名LBP受试者和80名无LBP的对照受试者。 我们将测试膀胱（BL）和胆囊（GB）经络上的穴位（AP）和非穴位（非AP），以及背部和腿部的非经络非AP。主要结局指标为：1）针旋转期间的峰值扭矩（扭矩）; 2）针振荡期间的针力衰减率（力衰减）; 3）针振荡期间皮下、肌周和肌肉区的组织位移（位移）; 4）肌周区厚度（厚度）。 我们的初步数据表明，在下背部针刺组织行为是异常的腰痛。我们假设扭矩和位移较小，并且1）LBP中的力衰减和厚度大于无LBP，2）子午线处大于非子午线处，3）AP处大于非AP处，4）背部大于腿部。 在LBP受试者中，我们还将检查这些结果测量与1）主观疼痛模式，2）触诊压痛之间的关系。 目标2：量化目标1中观察到的生物力学行为的组织材料特性：目标1中的数据将用于开发、评价和实施生物力学模型，以量化与三个组织区域（皮下、肌周和肌肉）相关的参数，包括刚度、阻尼和针/组织耦合时间常数。我们假设LBP的刚度更大，阻尼和针/组织耦合常数更小，与无LBP相比。这些参数还将用于生成关于可能导致LBP中异常软组织行为的结缔组织病理生理机制的进一步假设（例如，组织含水量增加或减少、异常结缔组织基质结构、胶原沉积增加或减少）。这些假设将在未来的研究中进行测试，这些研究将结合联合收割机超声弹性成像和组织活检在LBP和无LBP。 目的3：检查针刺期间组织行为与针刺前临床评估之间的关系： 在目标1中测试的所有受试者中，我们将对将针刺的区域的肌肉长度以及活动度（ROM）和功能评估进行临床测量。 这些测量值将与目标2中计算的参数进行比较。 我们假设刚度将呈负相关，阻尼和组织耦合常数将与相应肌肉群的肌肉长度和ROM以及物理性能指标呈正相关。这些数据将为未来的临床试验铺平道路，在一系列治疗之前和之后，使用主观（疼痛减轻，功能评估）和客观结果测量（超声弹性成像，大块被动组织硬度，运动学运动分析和肌肉活动）比较针灸和物理治疗的效果。 这项跨学科的研究桥接替代医学，物理治疗，工程，物理和骨科领域将提供客观的生物力学测量针灸的基本现象。 这项研究也可能1）导致对LBP的病理生理学的重要新见解和2）为未来的针灸和其他“替代”手动疗法以及物理和康复治疗的临床试验提供客观的生物学结果测量。